Restoration of a central incisor: direct composite Vs ceramic veneer
Case number 1
A patient had the incisal edge of her 11 impaired by an unsightly composite restoration, as a result of a trauma that occurred ten years before.
– age: 25 years old, old trauma. The clinical examination detects no particular sensitivity.
– aesthetic requirements & expectations: medium (the restoration has been done several years ago). The patient wants to improve the aesthetic aspect of the restoration with minimum invasive intervention
– The size of the lesion is about 25% of the crown and is favorable for a direct composite restoration
– Probability of a successful outcome: good
– Difficulty: medium
Case number 2
A patient comes to the office to replace an unsatisfactory composite restoration on tooth 11, done several times after a trauma that occurred 5 years ago.
– Age: 23 years old, the composite was redone several times to the great displeasure of the patient
– Aesthetic requirement: high. The patient asks for a «final» ceramic restoration.
– The size of the lesion is more than 1/3 of the tooth. No noticeable clinical signs except little sensitivity to cold
– Probability of a successful outcome: difficult
– Difficulty: this case needs an accurate ceramic work and a very skilled lab technician. The result is even more difficult to achieve, seen that only one central incisor is to be restored, identical to tooth 21, previously bleached and has a uniform surface texture and an internal individualized structure.
The smile picture shows the need to replace the old composite restoration on tooth 11.
1. contour line
2. internal dentinal structure
3. opalescent area
Intra oral view shows the lesion of 1/3 of tooth 11.
The therapeutic decision about direct Vs indirect single incisor restoration depends on several criteria: the age of the patient, the aesthetic requirement, the probability of the result, the difficulty of conception and longevity.
In addition, an important factor added to these various parameters is the ability of the operator and his taste for aesthetic restorations. In the direct method, the operator factor is essential: it must have a precise preoperative analysis (identification of the different structures, mastery of the composites and requirement in the finishing stages). For indirect restorations, the problem moves to the laboratory level; indeed, if the dentist can quickly achieve quality tooth preparations, then the issue of the know-how of the laboratory arises. Communication and sharing of precise documentation (high definition photos, polarized photos…) will facilitate the task of the technician. Finally, the last difficulty concerns the bonding protocol which must be carried out in a rigorous way. In summary, a restoration of a central incisor, whether in direct technique with composite or indirect bonded ceramics, is a real challenge.
- Manauta J, Salat A. Layers: an atlas of composite resin stratification. Quintessence 2012.
- Gauthier Weisrock, Jean-Louis Brouillet. Le champ opératoire évidemment. LINFORMATION DENTAIRE n° 42 – 3 décembre 2008.
- Devoto W, Saracinelli M, Manauta J. Composites in every day practice: How to choose the right material and simplify application techniques in the anterior teeth JEAD, Jan. 2010.
- Paris JC, Faucher AJ. Le Guide esthétique: comment réussir le sourire de vos patients. Quintessence international 2003.
- Galip G. The Science and Art of Porcelain Laminate Veneers. London: Quintessence, 2003.
- Carvalho RM. Effet de l’orientation des prismes sur la résistance à la traction de l’émail. Journal of Adhesive Dentistry, 2000,2:251-257
- Faucher AJ, Ortet S, Camaleonte G, Weisrock G, Etienne O, Paris JC. Réussir les composites antérieurs au quotidien. Quintessence. 2017